Comparison of four definitions of the metabolic syndrome in a Greek (Mediterranean) population

Abstract

Background:

There is a need to evaluate the prevalence of metabolic syndrome (MetS) diagnosed by the new Joint Interim Societies (JIS) MetS definition. The JIS definition was compared with three previous definitions to assess their ability to predict cardiovascular disease (CVD) risk.

Methods:

A cross-sectional analysis of a representative sample of Greek adults (n  = 9669) was performed to estimate the prevalence of MetS and CVD using the JIS vs. the three older definitions of MetS: the National Cholesterol Education Program-Adult Treatment Panel-III (NCEP-ATP-III), the International Diabetes Federation (IDF) and the American Heart Association/National Heart Lung and Blood Institute (AHA/NHLBI) definitions.

Results:

The age-adjusted MetS prevalence was 45.7%, 43.4%, 24.5% and 26.3% (ANOVA p  < 0.001) with the JIS, IDF, NCEP and AHA/NHLBI definitions. The prevalence of CVD was 11.4% in the whole study population and 17.6%, 18.3%, 23.3%, 22.6% and in subjects with MetS according to the JIS, IDF, NCEP and AHA/NHLBI definitions (ANOVA p  < 0.001). The prevalence of CVD was only 10.4% (i.e., lower than in the whole study population) in subjects with MetS according to the JIS but not according to the NCEP-ATP-III and AHA/NHLBI definitions (p  < 0.001 vs. subjects with MetS as defined by NCEP-ATP-III or AHA/NHLBI).

Conclusions:

When diagnosed according to the new JIS definition, the prevalence of MetS was high in a Greek Mediterranean cohort (nearly half of the adult population). The NCEP-ATP-III and AHA/NHLBI definitions were more predictive of CVD risk than the new JIS definition. These findings, though limited by the cross sectional analysis, may have implications regarding the choice of the definition to diagnose MetS.

Keywords::

• American Heart Association/National Heart Lung and Blood Institute
• Cardiovascular disease
• Consensus definition
• International Diabetes Federation
• Metabolic syndrome
• National Cholesterol Educational Program

Transparency

Declaration of funding

The authors have not received any payments in relation to the preparation of this paper. No pharmaceutical company supported or was involved with the preparation of this paper. No professional writer was involved. The study was funded by the Hellenic Atherosclerosis Society.

Declaration of financial/other relationships

V.G.A., E.S.G., K.T., A.A.P., P.A., T.G., K.K, E.K.M., A.K., D.P.M., have given talks, attended conferences and participated in trials and advisory boards sponsored by various pharmaceutical companies. All authors have disclosed that they have no direct employment by a pharmaceutical company; D.P.M. is member of an MSD advisory board.

Acknowledgements

The authors thank the Hellenic Atherosclerosis Society, the Hellenic Society of General Practitioners and the following colleagues for the collection of data: Ahladas H (HC); Akritopoulos P (GH); Apousidou VP (GH); Arseniou A (HC); Athanasiou PI (HC); Bathianaki M (HC); Batou ND (HC); Bouloukos VI (UH); Bourdouvalis IA (HC); Dimopoulou SP (HC); Dionisopoulou SG (GH); Georgaki AN (HC); Gazis E (UH); Giapoutsidis V (GP); Giouleme O (UH); Goudevenos IA (UH); Hartaba VG (HC); Kalaitzidou EL (GP); Karaleftheri MP (HC); Karotsis AL (GP); Kapousouzi MI (HC); Kesidou NI (HC); Kiourtzidou BL (HC); Kouroudi AI (HC); Lazaridou PG (HC); Liakou K (HC); Matsou AT (HC); Messios R (HC); Monedas I (HC); Notaridis G (HC); Patroklou S (HC); Paulidou H (HC); Pehlivanidis AN (UH); Petridis DI (HC); Polychronidis E (HC); Posnahidou DN (HC); Prokopiadou D (GP); Prokopidis D (GP); Protopapas N (HC); Psaltoglou I (HC); Sarigianni M (GH), Satsoglou EA (GH); Sekeri ZP (HC); Sfakianakis M (HC); Symeonidis A (HC); Tsakiris K (HC); Tsakoundakis N (GP); Troulaki Z (HC); Tsiknaki SB (HC); Vasilopoulou D (HC); where UH denotes University Hospital, GH General Hospital, GP General Practice, HC Health Center.